Iowa Mental Health and Disability Services System Redesign Interim ...

families from among the different disability groups receiving services under the auspices of
the regions.
• There was discussion of whether DHS or another representative of the state should have a
seat on the governing boards of the regions. The consensus is that because the state will
enter into and enforce performance contracts with the regions, it should not also have a
seat on the governing boards.
• There was consensus that providers should have an active role in advising Regions in service
system planning, implementation and quality improvement, but that providers should not
be included in the governing boards. It should be noted that one Workgroup member made
cogent arguments for including at least one provider on the governing board. The basis for
that position is (a) that providers are increasingly important partners with the MH/ID-DD
system as a whole and the Counties/Regions in particular; and (b) that national health
reform models of provider-sponsored accountable care organizations and health homes
provide models for the roles of providers in the leadership and governance of systems of
care. It was suggested that the provider council established by each region could nominate
a provider to serve on the governing board. However, the majority of Workgroup members
maintain the position that providers should not be included as voting members of the
governing boards.
• There was consensus that 28E agreements governing regions could either support creation
of a new organizational entity or could cement a regional consortium of participating
counties. The suggested topic areas to be covered by 28E agreements are listed below.
Regional financial management
• There was consensus that the regions should utilize a single “checking account” into which
county levy funds 54 would be deposited and from which county levy funds would be spent.
It was agreed that maintaining separate accounts for county levy funds within each county
was inefficient and could increase “transactional friction”. This consensus was reached after
much discussion of various options, and is based on the ability of regions to use information
technology to report expenditures by consumer, service and provider at the county level.
This transparency of reporting will allow each participating county to maintain stewardship
of locally-levied funds for MHDD services.
Topics for 28E agreements
This list of topics is derived from (a) a review of the current Iowa statute governing 28E agreements; (b)
the 28E agreement now in force for the one fully-functional multi-county MHDD region in Iowa (County
Social Services); and (c) examples of similar inter-local agreements from other multi-county jurisdictions
in other states.
• Purpose: the goals and objectives of entering into the interlocal agreement.
54 Plus state funds allocated to the regions and any other sources of revenues.
91